Because the causes of health disparities are so structural in origin and deeply entrenched into the fabric of American culture, many of the ultimate solutions are likely to reside in drastic changes in those structures that breed disparities: racism, economic institutions that perpetuate inequality, a political system driven by the interests of the very wealthy, etc.
While even the most optimistic of health justice activists doesn’t believe that a drastic overhaul of these inequality-driving structures is realistic, they still engage in health justice activism because they recognize that there are several entry points for improvement, micro-goals and movements that can make an effective dent in health disparities.
Goal-creation in health justice has several components: (1) Understanding the moral and ethical pulse of the society in which we operate. (2) Understanding the legal and political process (3) Balancing our activism-imagination with elements (1) and (2).
Understanding the moral and ethical pulse of society includes keeping abreast of national (or local, should your interests be local) needs, priorities and opinions. The opinions of others should not necessarily dictate the content of the goal but rather, how that goal is framed, how it is discussed, how it is formally proposed.
For example, an activist living in a socially conservative voting district will have to be careful in how they frame a proposal for harm reduction programs or sexual education curricula in middle schools. Again – this is not to say that one should attempt to placate people in power (one should never fear disagreement) but rather because the language used to propose change should be digestible to decision-makers. Understanding the legal process is simply having a grasp on exactly how changes are implemented into society.
“Balancing our activist imagination” is the fun part: Armed with an understanding of how the world feels and how to implement change we can begin to dig deep for solutions that we find realistic, relevant and worth our effort.
These can be divided into two categories: (a) short-term (10-year) goals and (b) goals achievable within “our lifetime.” In this spirit, I’ve proposed a set of changes that fit the aforementioned criteria:
- New health care provider education models: These include new models on how to educate health care providers. This includes drastic overhauls in how professionals are educated to treat an increasingly diverse US population. This also involves an emphasis on preventative health education for all healthcare providers and a better understanding of statistics and the evaluation of evidence, so as to deliver more consistent and fair evidence-based healthcare delivery. Overhauls in medical education could also address the provider-dearth problem: perhaps there are novel ways to education more providers in an efficient manner sufficient to meet the growing need for providers in underserved areas (rural areas in particular).
- New preventative health models: As the data on the efficacy of preventative measures grows, we will be in a better position to emphasize some practices over others. In the case of epidemics like obesity and diabetes, some education and outreach approaches are more effective at curbing unhealthy behaviors than others. National initiatives like First Lady Obama’s “Let’s Move” might be determined to be effective, and consequently, be crystallized into standard practice. This is a realistic and relatively easy to implement approach to improving preventative health practices and is achievable in a relatively short period of time.
- The birth of personalized medicine: In many ways, bio-medicine hasn’t lived up to its promise; “transformative” scientific ventures like the Human Genome Project have yet to deliver any concrete discoveries that appreciably impact disease progression. It is, however, too soon to write off the potential for biomedical advances to profoundly impact the way disease is diagnosed and treated. Personalized medicine hopes to tailor specific treatments to individuals based on their own genetic and physiological blueprints. This is based on the reality that individuals differ in how certain conditions progress and how they metabolize drugs. These differences are often rooted in heritable differences that genomic medicine can identify. The goal for genomic medicine is to delivery more personalized approaches to diagnosis and treatment, whereby patients can receive tailor-made therapies. This represents a potential solution to health inequities in several diseases because it may improve the efficacy of therapeutic interventions and limit the wasteful use of therapies. In addition, this technology can affect the influence of clinician bias as a determinant of health: diagnoses and treatment plans would have less to do with the subjective judgment of clinicians and on the objective measurement of interventions. Strangely, many health justice activists see these technological interventions as outside the ideological scope of health activism. The opposite is true: genomic and personalized medicine holds promise for limiting the impact of discrimination on the lives of Americans.
- Implementation of a single-payer like healthcare system: Believe it, or not, this prediction is independent of my personal preference, but rather, a realistic predication based on global trends. That the United States is the only country among the G8 who does not have a nationalized healthcare system is not a random quirk; despite spending more money on healthcare than any country in the world, the United States performs poorly in a host of health care indicators. The progress toward a single-payer system in the United States will be slow and incremental but likely to eventually win out in the face of concrete evidence that such a system would constitute the most logical, sensible and efficient way to deliver healthcare. The healthcare system debates are currently wallowing in juvenile debates over “freedom.” The hope is that these debates will evolve in time and individuals will understand that government-managed healthcare is no more an infringement on individual liberty than a government-protected militia. In this future, human rights and justice dialogue might prevail, with the country’s leading economists and politicians structuring a substantive government managed system that emphasizes prevention and primary care and has instruments in place to ensure that certain areas of the country are properly served. As we all know, a healthcare delivery system does not necessarily equate to a decrease in health disparities, however, equitable access is a necessary component.
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